Archive

Caveat Emptor? Or Primum Non Nocere?

In 2004 my wife and I bought a house. Shortly after moving in, we discovered that the furnace needed replacing. Who was responsible for the cost of the replacement? You might reason that it was our responsibility, that we should have done due diligence prior to the purchase. (In fact,

Is American Healthcare Disruptible?

Healthcare blogs lit up last week to dissect the latest demise of a flashy health tech startup. Forward Healthcare was founded by former Google and Uber executives with a goal of “disrupting primary care.” They placed space-ship like pods in shopping malls where patients could talk with AI chatbots about

The Three Meanings of "Healthcare"

What does the word “healthcare” mean? You might think the meaning is obvious, that healthcare is simply about taking care of patients and their health needs. But in fact, healthcare has three very different meanings. By mixing the three together under a single word, we’ve muddied our collective understanding,

Does ChatGPT really have a better bedside manner than a human doctor?

I just finished reading Abraham Verghese’s 2009 bestselling novel Cutting for Stone. It’s a sort of extended love letter to old school practice of medicine. You know, the good old days, when physicians were in charge and were highly respected. I’m not sure everything about those old

Value Creation vs. Value Extraction: A Tale of Two Healthcare Startups

The success or failure of any capitalist system, as Adam Smith pointed out 250 years ago, rests on its ability to reward value creation more than value extraction. Both creation and extraction can make you rich, but only one improves our world. If I invent a better mousetrap and you

What Do NFL Owners Know About Private Equity that Doctors Don't?

The National Football League’s owners just approved, for the first time, private equity investment in NFL teams. The new rule allows owners to sell up to 10% of a team to a PE firm, with some additional restrictions: -- The PE firms have to hold on to each investment

What Mohair Subsidies Teach us about Healthcare Lobbying

This week’s newsletter was inspired by Wendell Potter’s excellent Healthcare Uncovered substack. (You should definitely subscribe to it if you haven’t already). In a recent entry, Potter describes the US Chamber of Commerce’s long history of lobbying on behalf of pharma and health insurer interests. For

A Strategy Lesson from the Restaurant Industry

I met an old friend for lunch last week at a trendy restaurant near my Salt Lake City home. It’s one of those places that happens to be popular with the “beautiful people;” my children who work there bring home reports of local, and occasionally global, celebrity sightings. Not

Irish Dairies and Honesty Shops

This week’s newsletter was inspired by a LinkedIn post from Rob Chestnut. Chesnut is the former general counsel and chief ethics officer for AirBnB; he now writes and lectures about business ethics. His post described a visit to his Irish ancestral home, including a visit to an ‘Honesty Shop”

Why are nursing homes so understaffed?

If one of your family members has ever needed nursing home care, you probably know this feeling of worry. With all the horror stories out there in the news, how can you know whether a particular nursing home is any good? How can you trust that they’ll take good

Why strawberries and healthcare are much better in Europe than in the US

When’s the last time you ate a really good strawberry? I don’t mean one of the tasteless monstrosities on display at a typical American grocery store (or worse, Costco). I mean one that’s absolutely packed with flavor and sweetness. (Hopefully it hasn’t been so long that

Theater and Healthcare: Two Industries That Aren't Just About Money

Have you head the old joke about the theater business, the one that says you can make a killing, but you can’t make a living? I ran across it last week on the Freakonomic podcast, where Stephen Dubner used the Broadway smash hit Stereophonic as a springboard to an

What Should Hospital Leaders Expect From a CFO?

An article in this past week’s Becker’s Hospital Review, based on interviews with hospital chief financial officers, caught my eye and then boiled my blood. Here’s the bit that upset me: "Another factor that has helped [the health system] improve its overall operating performance is by

What Gambling Athletes Teach Us About Integrity in Healthcare

Oakland A’s relief pitcher Michael Kelley recently learned a very hard lesson. A $740,000 lesson. Ten years ago, while he was still scraping his way up through the minor leagues, he placed a few small bets (less than $100 in all) on a handful of major league baseball

Improving Patient Access to NIH-Developed Technologies

The National Institutes of Health (NIH), which at $45B/year is arguably the world’s premier funder of academic medical research, recently issued a request for public comment on a draft policy. Like all government policies, this one is pretty wonky. But it addresses an important issue, namely the affordability

How Should Hospitals Report Financial Performance?

Consider these three hypothetical business press headlines: Los Angeles Police Department posts $935M operating profit in Q1 Chicago Archdiocese exits the red with $356M Q4 gain Disney’s Human Resources Department posts $20M operating loss in Q1 These feel off, right? Talking about profits in the case of public sector

Can Communities Save Healthcare?

My wife and I recently attended the National Theatre production of Nye, about the life and career of Aneurin "Nye" Bevin. He's the British politician credited with founding the UK National Health Service. Bevin grew up a century ago in Tradegar, a town in southern Wales.

The Failed Walmartization of Primary Care

Last week, Walmart surprised the business world with their announcement that they were shutting down all of their 51 health clinics along with their telehealth program.  Why do companies like Walmart keep failing at primary care? The consensus seems to be that it’s just too difficult. This opinion piece

Physician Noncompete Agreements

The Federal Trade Commission dropped a bombshell last week, a new rule that bans most noncompete clauses in employee contracts. One of the many trade groups in opposition is the American Hospital Association, who is particularly upset about losing noncompete clauses in physician contracts. Now, employee noncompetes have long been

Superstar Hospital CEOs

This week’s newsletter was inspired by two stories out of Fresno California. In one, the Fresno Bee reported that Valley Children’s Hospital has paid $10M for naming rights to the Fresno State University football stadium. The deal includes a catered luxury suite for home games, as well as

Must the Sky Be the Limit on Drug Prices?

A new world record for drug prices was set last week. Orchard Therapeutics announced that they will charge $4,250,000 per patient for Lenmeldy, a gene therapy for metachromatic leukodystrophy.   Which raises a few questions: * How did the company come up with this price? * Is this therapy really worth

Patient (Cyber) Safety

I’m writing this week’s newsletter from one of the reading rooms at the British Library. (I promise this is relevant to the topic.) Despite Prince/King Charles’ opinion that they feel like assembly halls of an academy for secret police (does he know something we don’t?) the

Penicillin, Syphilis, and Drug Shortages

I recently visited the Alexander Fleming museum at St. Mary’s Hospital, London, together with my friend and fellow pathologist Dr. Suzanne Dintzis. It’s a tiny museum, maybe 20 square meters in all, consisting mainly of Fleming’s original laboratory where he discovered penicillin. Suzy and I had fun

Should Hospitals Pay for Luxury Yachts and Private Jets for their Owners?

Over the past couple of decades, a large number of formerly non-profit hospitals, health systems and health insurers have been purchased by for-profit corporations. Many of them purchases were initially defended as “rescues” but later turned out badly, raising serious questions about who should be allowed to own a healthcare

Pancakes and Professions

Of the many strange and wonderful quirks of London history, one that particularly fascinates me are its Livery Companies (“livery” referring to the distinctive uniforms they wore on formal occasions). Ever since the establishment of the Weaver’s Company in 1155, these trade guilds have played a significant role in

Do We Need More Competition in Healthcare?

Peter Schickele, best known as the “discoverer” of PDQ Bach, died this past month at the age of 88. A classical music composer, humorist, and educator. Or, to use his own description, a professor of musical pathology at the [fictional] University of Southern North Dakota at Hoople.  After seeing news

Healthcare is a Calling.

Lisa Rosenbaum is a cardiologist and medical humanist who frequently writes for the New York Times. Last week, the New England Journal of Medicine published an essay of hers that explored whether doctors still see medicine as a calling, as opposed to a job, and whether this is a good

Who Would Name a Healthcare Award after Martin Shkreli?

The Lown Institute’s 2023 Shkreli award ceremony took place last week. Some background: The Lown Institute is a think tank established in 2012 (its predecessor, the Lown Cardiovascular Research Foundation, was founded in 1974) by Dr. Bernard Lown, a Harvard cardiology professor famous for his contributions to cardioversion back

Airplanes and Doctors

This past week, passengers aboard a Boeing 737 Max experienced the terror of a person-sized hole suddenly opening up in the side of the plane mid-flight. While no one was killed or seriously injured, it appears that they were extremely lucky. The plane had not yet reached cruising altitude, and

Trust

I went on an Apple odyssey this week. I was trying to create a second Apple ID in order to download apps both in the US and in the UK, and I kept running into an error on Apple’s website. Two days and many hours and two visits to

On Doctors and Language Skills

Sitting at Christmas midnight mass this past weekend at St. Martin-in-the-Fields, I heard the family next to me conversing in French. The next day I joined a Dickens-themed walking tour of central London alongside a large group of Dutch speakers. (The tour was in English, but the London-accented guide mentioned

Dear AI Santa: Are You Real? And Can You Send Me a (Human) Doctor for Christmas?

In December 2020, in the midst of the COVID-19 pandemic and just prior to the first vaccines, parents around the world grappled with a question: Would their children be able to sit on Santa’s lap this year? It seemed clear by then that young children were at low risk

Management as a Prerequisite to Good Culture

I’ve been thinking this week about leadership and professional management, thanks to two news articles and one podcast on a particular non-healthcare domain: policing. Police culture obviously differs from healthcare culture in some ways, but I think the two domains also have some key elements in common. More on

Making Healthcare Worse, One Metric at a Time

Everyone knows that organizations need metrics. Your goals need to be SMART (Specific, Measurable, Achievable, Relevant, and Time-bound). You need KPIs (Key Performance Indicators). And pay should be based on performance, which is to say, based on quantitative metrics. Right? Not so fast. Measurement is a powerful managerial tool. And

How Both Healthcare and Higher Education Keep Shooting Themselves in the Foot.

This week’s newsletter was inspired by this episode of one of my favorite podcasts. Host Steven Levitt (of Freakonomics fame) interviewed Michael D. Smith, an economist at Carnegie Mellon, about the discouraging state of American higher education. As I was listening, I was struck by just how many of

What can Healthcare Learn From Cranberry Farming?

Just in time for Thanksgiving, the Wall Street Journal ran an article on the cranberry business. It’s a fascinating business story with potential implications for the healthcare industry. It turns out that 2/3 of the global cranberry business is owned by a single corporation, Ocean Spray. Unlike most

My Techno-Safety Optimism Manifesto

“We need to discuss what kind of society we want. Technology can accelerate us down a good path or a bad path. The question isn’t always how to engineer better software but how to ensure humans behave more ethically.” --Dr. Yuri Quintana from Beth Israel Deaconess Medical Center, quoted

The Problem with Wellness

Hospital (n). From Old French, 13th century. “Hospital” shares etymology with the word “hospitality” which, despite its modern association with restaurant and hotel businesses, originally meant being generous and kind to strangers in need. Every time I hear doctors and healthcare leaders say that the healthcare system needs to shift

Abundance, Not Scarcity

This week’s newsletter is inspired by a sermon delivered yesterday at one of my favorite churches, by one of my favorite preachers (the brilliant Rev. Sally Hitchener) She used the biblical story about the exodus of the Israelites to explain the value of an abundance mindset versus a scarcity

So Cancer Screening Doesn’t Actually Save Lives?

Cancer screening has been showing up in the news a lot lately. First, there was Kim Kardashian’s Instagram advertisement for a company named Prenuvo that does full-body MRI scans on healthy people to look for cancers (and anything else they can find). Another company getting attention for cancer-hunting, but

The Technologic Fallacy

My family and I recently saw the new Oppenheimer movie. The scenes that struck me the most were of the crowds cheering after the Trinity test. How on earth could people have been ecstatic about the creation of the most destructive human-made force in history? But of course they were.

Patents vs Prizes

21 July 2023 Photo: Painting of John Harrison (Thomas King, 1767). The original hangs in the Science and Society Picture Gallery in London. For a number of years, Sen Bernie Sanders (I-VT) has been pushing a proposal to replace drug patents with a system of prizes. But the idea didn’

Nevada to the Rescue

11 July 2023 The latest health data privacy move just came from an unexpected location (unexpected for me, anyway): Nevada. Why Nevada of all places? Part of the answer lies in the current politics of data privacy law. Because of lack of progress in Washington, a number of states have

"Coding Destroys Everything"

3 July 2023 When you think about the root causes of dysfunction in US healthcare, what word comes to mind first? A lot of Americans would say cost (or cost inflation). Policy people would likely say access (probably followed by cost). Based on their personal experiences working in healthcare, physicians

National Quality Ranking Program, or Hospital Beauty Contest?

26 June 2023 This week, Penn Health became the second health system in the US to opt out of cooperating with the US News and World Report hospital rankings. The first health system to opt out was St. Luke's University Health Network, also in Pennsylvania. In contrast to

Why the Health Plan Industry Wants Healthcare Costs to Keep Rising

12 June 2023 Interesting lawsuit story of the week, courtesy of this StatNews article. On one side are the Connecticut branches of two unions: the International Union of Bricklayers and Allied Craftworkers, and the Sheet Metal Workers International Association. On the other side is Elevance Health, a for-profit insurance company

Most Hospitals Are No Longer Charities (But Ought To Be)

7 June 2023 (Image: “Barts in Medieval Times” from the Wellcome Collection. St. Bartholemew’s Hospital was one of only two large Catholic hospitals in London that escaped Henry VIII’s “suppression” of religious institutions.) Through most of history, hospitals were run as charities. True, given the pre-scientific state of

ChatGPT outperforming doctors on empathy, and the growing chorus over AI regulation

25 May 2023 Hot medical journal article of the week, courtesy of JAMA Internal Medicine. This article has been blowing up all over LinkedIn and Twitter. * Here’s what the authors did: They downloaded 195 different questions that had been asked by patients on a Reddit forum, such as “I